Practice Management

You Can Learn A Lot From Billing Data.

Because hospitalists lack a specialty code for billing (probably forthcoming), and we do not have formal board certification (I would bet it's in our future), anyone interested in identifying hospitalists beyond their hospital walls has a tough slog.  You can call several thousand hospitals and speak with the appropriate department and question; you can call every internist, pediatrician or family practitioner in the AMA database and ask them, "Are you a hospitalist?"; or you can find an alternate method---because the latter two will keep you busy until the next solar eclipse. Knowing adult inpatient practitioners bill just a small cluster of codes--observation, critical care, or inpatient--having access to a national database with physician billing data (Part B submissions) would provide a route to determine which docs practice in acute care settings.   (more…)

Will Nurses Be Part of the Answer to HM Sustainability?

by Leslie Flores
In my last post I suggested that in order for hospital medicine to be both financially and professionally sustainable, we need to figure out how hospitalists can see more patients each day while at the same time be more satisfied with their work. One possible approach to achieving this aim is to support physician hospitalists with less costly staff doing work not requiring a physician’s license or expertise. The most common skill mix diversification approach in Hospital Medicine Groups (HMGs) has been to add NPs and/or PAs to the team. SHM’s 2014 State of Hospital Medicine Report indicates that more than 65% of HMGs serving adults have one or more NP/PAs practicing in them. Over the last year or two, though, I’ve increasingly encountered the presence of nurses (usually RNs, though sometimes LPNs) in clinical roles supporting hospitalist practices. A few groups have incorporated nurses for years, but now more…
Leslie Flores is a founding partner at Nelson Flores Hospital Medicine Consultants, a consulting practice that has specialized in helping clients enhance the effectiveness and value of hospital medicine programs as well as those in other hospital-focused practice specialties since 20104. Ms. Flores began her career as a hospital executive, after receiving a BS degree in biological sciences at the University of California at Irvine and a Master’s in healthcare administration from the University of Minnesota. In addition to her leadership experience in hospital operations, business development, managed care and physician relations, she has provided consulting, training and leadership coaching services for hospitals, physician groups, and other healthcare organizations. Ms. Flores is an active speaker and writer on hospitalist practice management topics and serves on SHM’s Practice Analysis and Annual Meeting Committees. She serves as an informal advisor to SHM on practice management-related issues and helps to coordinate SHM’s bi-annual State of Hospital Medicine Survey.

Physician Assessment Gone Bad

  Some in our profession have begun to think hard about our future pay and incentives, especially given the vagueness of the recently passed MACRA legislation. MACRA replaced the SGR and put in place a model of compensation that in theory balances both physician accountability and just rewards for hard work.  The two MACRA tracks, the Merit-Based Incentive Payment System (MIPS) or the Alternative Payment Model (APM) are long on promise, however, but short on substance.  Read here for more (a brief and outstanding NEJM commentary). So much needs working out, and first among them requires us to deliver an appropriate means by which to assess physician achievement.  We have no functional framework to work off of and no history as a guide. How do you evaluate a provider when few valid instruments to measure performance exist? How do you reward a doctor for value when your metrics do not…